| NPI | 1104498492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: ND PT21471) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL17384) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2024-09-04 |